Human seminal plasma (HSP)
hypersensitivity is defined as a spectrum of systemic and/or localized symptoms after exposure to specific
protein components in seminal plasma. The major
antigen is believed to be
prostate-specific antigen, but other
proteins are likely involved in this heterogenous disorder. There are no known risk factors for developing seminal plasma
hypersensitivity, although women who develop systemic symptoms are more frequently atopic. Of interest, for both systemic and localized forms, symptoms can manifest after first time intercourse in up to 50% of cases. Diagnosis requires a careful history. The gold standard for diagnosing HSP is that symptoms are completely abated with the use of a
condom prophylactic. Although women with HSP
hypersensitivity often have difficulty conceiving due to their inability to have unprotected sexual intercourse,
infertility has not been demonstrated to be related to HSP
hypersensitivity. Patients with HSP
hypersensitivity often elicit positive skin prick testing and/or serum-specific
immunoglobulin E to whole seminal fluid or fractionated
seminal plasma proteins. Treatment involves either avoidance with the use of
condoms, an intravaginal graded challenge using dilutions of whole seminal fluid, or subcutaneous desensitization to relevant fractionated
seminal plasma proteins obtained from the woman's sexual partner. In most cases, treatment using ≥ 1 of the above approaches has been very successful.